Nineteenth-century medical advances were entwined with a conceptual innovation: the idea that many cases of disease which were previously thought to have diverse causes could be explained by the action of a single kind of cause, for example a certain bacterial or parasitic infestation. The focus of modern epidemiology, however, is on chronic non-communicable diseases, which frequently do not seem to be attributable to any single causal factor. This paper is an effort to resolve the resulting tension. The paper criticises (...) the monocausal model of disease, so successful in the nineteenth century. It also argues that a multifactorial model of disease can only be satisfactory if it amounts to more than a mere rejection of the monocausal model. A third alternative, the contrastive model, is proposed and defended on the grounds that it links the notions of disease and of general explanation, while avoiding the philosophical naiveties and practical difficulties of the monocausal model. (shrink)

This paper argues that the medical conception of health as absence of disease is a value-free theoretical notion. Its main elements are biological function and statistical normality, in contrast to various other ideas prominent in the literature on health. Apart from universal environmental injuries, diseases are internal states that depress a functional ability below species-typical levels. Health as freedom from disease is then statistical normality of function, i.e., the ability to perform all typical physiological functions with at least typical efficiency. (...) This conception of health is as value-free as statements of biological function. The view that health is essentially value-laden, held by most writers on the topic, seems to have one of two sources: an assumption that health judgments must be practical judgments about the treatment of patients, or a commitment to "positive" health beyond the absence of disease. I suggest that the assumption is mistaken, the commitment possibly misdescribed. (shrink)

The aim of the paper is to give an ontologically informed account of disease that can aid in the construction of disease ontologies. The paper begins by distinguishing cases of diseases from what are purely structural abnormalities, referred to as ‘disorders’. The paper then presents a causal model apt for the understanding of disease that distinguishes diseases from both their causes and their potential effects. The analysis of disease defended treats disease in terms of distortions of standard cellular network processes, (...) where those distortions are incapable of self remedy and produce biologically disadvantageous symptoms. (shrink)

This paper examines the way in which causal relations are understood in the dominant model in contemporary medicine. It argues that the causal relation is not definable in terms of the condition relation, but that in general for conditions of an occurrence to be among its causes they must answer instrumental interests in a certain way, and there are further criteria for distinguishing 'the' cause of a disease (i.e., its etiological agent) from other causal factors, which are based upon instrumental (...) interests peculiar to medicine. It also argues that diseases are complex processes of which both clinical and underlying patho-physiological manifestations are proper parts (as contrasted with effects). (shrink)

The frequent occurrence of comorbidity has brought about an extensive theoretical debate in psychiatry. Why are the rates of psychiatric comorbidity so high and what are their implications for the ontological and epistemological status of comorbid psychiatric diseases? Current explanations focus either on classification choices or on causal ties between disorders. Based on empirical and philosophical arguments, we propose a conventionalist interpretation of psychiatric comorbidity instead. We argue that a conventionalist approach fits well with research and clinical practice and resolves (...) two problems for psychiatric diseases: experimenter’s regress and arbitrariness. (shrink)

Identifying the necessary and sufficient conditions for individuating and classifying diseases is a matter of great importance in the fields of law, ethics, epidemiology, and of course, medicine. In this paper, I first propose a means of achieving this goal, ensuring that no two distinct disease-types could correctly be ascribed to the same disease-token. I then posit a metaphysical ontology of diseases—that is, I give an account of what a disease is. This is essential to providing the most effective means (...) of interfering with disease processes. Following existing work in the philosophy of medicine and epidemiology (primarily Christopher Boorse; Caroline Whitbeck; Alexander Broadbent), philosophy of biology (Joseph LaPorte; D.L. Hull), conditional analyses of causation (J.L. Mackie; David Lewis), and recent literature on dispositional essentialism (Stephen Mumford and Rani Anjum; Alexander Bird), I endorse a dispositional conception of disease. Following discussion of various conceptions of disease-identity, their relations to the clinical and pathological effects of the diseases in question, and how diseases are treated, I conclude (i) that diseases should be individuated by their causes, and (ii) that diseases are causal processes best seen as simultaneously acting sequences of mutually manifesting dispositions. (shrink)

The ontology of medicine—the question of whether disease entities are real or not—is an underdeveloped area of philosophical inquiry. This essay explains the primary question at issue in medical ontology, discusses why answering this question is important from both a philosophical and a practical perspective, and argues that the problem of medical ontology is unique, i.e., distinct, from the ontological problems raised by other sciences and therefore requires its own analysis.

This essay discusses four key criticisms recently leveled against the main attempts to use conceptual analysis to understand health and disease. First, it examines the weaknesses of these attempts and suggests a better way to proceed. Next, it briefly discusses another disease debate concerning pathological mechanisms and suggests that this approach could be more fruitful than that of conceptual analysis. The final section demonstrates how Georges Canguilhem's biological philosophy of disease avoids some of the problems associated with conceptual analysis, and (...) how he can contribute to both debates. Canguilhem's appeal to biological normativity is understood as contributing to a theoretical explanation, and a possible naturalization, of what is specific to healthy and pathological phenomena. (shrink)

Many philosophers and medical scientists assume thatdisease categories or entities used to classify concrete cases ofdisease, are often defined by disease mechanisms or causalprocesses. Others suggest that diseases should always be definedin this manner. This paper discusses these standpoints criticallyand concludes that they are untenable, not only when `diseasemechanism' refers to an objective mechanism, but also when`mechanism' refers to a pragmatically demarcated part of thetotal ``objective'' causal structure of diseases. As an alternativeto principles that use the concept of disease mechanism (...) oranalogous concepts, a pragmatic approach is suggested anddescribed. This approach has been suggested before, but inproblematic or inadequate versions. This paper proposes a versioncompiled of two ``pragmatic principles'' and shows that they aremuch more adequate than the principle of disease mechanism. Withreference to a case study of a still ongoing internationaldiscussion of various candidates for a classification system formalignant lymphomas, including REAL (Revised European–AmericanClassification of Lymphoid Neoplasms) in which the concept ofdisease mechanism or analogous concepts plays a very small part,it is shown just how pivotal these two pragmatic principles canbe in actual discussions of definitions of diseases. Finally, itis pointed out that with regard to modern philosophy of languageit may, at least in some cases, be problematic to distinguishbetween the two pragmatic principles as they stand. (shrink)

Mumford puts forward a new theory of dispositions, showing how central their role in metaphysics and philosophy of science is. Much of our understanding of the physical and psychological world is expressed in terms of dispositional properties--from the spin of a sub-atomic particle to the solubility of sugar. Mumford discusses what it means to say that something has a property of this kind and how dispositions can possibly be real things in the world.

Conceptual analysis of health and disease is portrayed as consisting in the confrontation of a set of criteria—a “definition”—with a set of cases, called instances of either “health” or “ disease.” Apart from logical counter-arguments, there is no other way to refute an opponent’s definition than by providing counter-cases. As resorting to intensional stipulation is not forbidden, several contenders can therefore be deemed to have succeeded. This implies that conceptual analysis alone is not likely to decide between naturalism and normativism. (...) An alternative to this approach would be to examine whether the concept of disease can be naturalized. (shrink)

Biological science does not try to distinguish between health and disease. Biology is concerned with the interaction between living organisms and their environment. What we call health or disease is quite irrelevant.These reactions between the individual and his environment are complex. The individual and his surroundings form an integrated system which we can arbitrarily divide into two parts. There is an “external” component, by which we mean such factors as light, heat, percentage of oxygen in the air, quantity of minerals (...) or vitamins in food, micro-organisms in food or air, and so on. These can induce changes in what we arbitrarily call the “internal” component. Here we include such crude factors as anatomical structures, or finer details like composition of intercellular fluid, or secretions of glands, or changes of electrical potential in nerve or muscle. (shrink)

In order to develop the ontology of tendencies for use in the representation of medical knowledge, tendencies are compared with other kinds of entities possessing the realizable-realization structure, specifically: dispositions, propensities, abilities and virtues. The peculiarities of tendencies are discussed and a standard schema of tendency ascription is developed in order to represent the relations between the ascriptions of tendency tokens to particulars and the ascriptions of tendency types to universals. Two nonstandard cases and their epistemic variants are discussed.

The concept of disease has been the subject ofa vast, vivid and versatile debate. Categoriessuch as ``realist'', ``nominalist'', ``ontologist'',``physiologist'', ``normativist'' and``descriptivist'' have been applied to classifydisease concepts. These categories refer tounderlying theoretical frameworks of thedebate. The objective of this review is toanalyse these frameworks. It is argued that thecategories applied in the debate refer toprofound philosophical issues, and that thecomplexity of the debate reflects thecomplexity of the concept itself: disease is acomplex concept, and does not easily lenditself to definition.

Debate over the nature of science has recently moved from the halls of academia into the public sphere, where it has taken shape as the "science wars." At issue is the question of whether scientific knowledge is objective and universal or socially mediated, whether scientific truths are independent of human values and beliefs. Ronald Giere is a philosopher of science who has been at the forefront of this debate from its inception, and Science without Laws offers a much-needed mediating perspective (...) on an increasingly volatile line of inquiry. Giere does not question the major findings of modern science: for example, that the universe is expanding or that inheritance is carried by DNA molecules with a double helical structure. But like many critics of modern science, he rejects the widespread notion of science--deriving ultimately from the Enlightenment--as a uniquely rational activity leading to the discovery of universal truths underlying all natural phenomena. In these highly readable essays, Giere argues that it is better to understand scientists as merely constructing more or less abstract models of limited aspects of the world. Such an understanding makes possible a resolution of the issues at stake in the science wars. The critics of science are seen to be correct in rejecting the Enlightenment idea of science, and its defenders are seen to be correct in insisting that science does produce genuine knowledge of the natural world. Giere is utterly persuasive in arguing that to criticize the Enlightenment ideal is not to criticize science itself, and that to defend science one need not defend the Enlightenment ideal. Science without Laws thus stakes out a middle ground in these debates by showing us how science can be better conceived in other ways. (shrink)

How should we define ‘health’ and ‘disease’? There are three main positions in the literature. Naturalists desire value-free definitions based on scientific theories. Normativists believe that our uses of ‘health’ and ‘disease’ reflect value judgments. Hybrid theorists offer definitions containing both normativist and naturalist elements. This paper discusses the problems with these views and offers an alternative approach to the debate over ‘health’ and ‘disease’. Instead of trying to find the correct definitions of ‘health’ and ‘disease’ we should explicitly talk (...) about the considerations that are central in medical discussions, namely state descriptions and normative claims . This distinction avoids the problems facing the major approaches to defining ‘health’ and ‘disease’, and it more clearly captures what matters in medical discussions. (shrink)

In historical perspective the book presents some logical concepts underlying medical thinking--definition, diagnosis, classification, semeiology, the ontology of disease, causation, scientific method, so-called "scientific medicine" and kindred topics. Histories of concrete diseases especially tuberculosis, illustrate these concepts "in action" over several centuries, within their contemporary intellectual environment. The thought modes of the earlier physicians, absurd as they may seem today, often showed excellent logic. Historically, medical thinking remains surprisingly constant, despite spectacular scientific "progress".

'Why did the window break when it was hit by the stone? Because the window is brittle and the stone is hard; hardness and brittleness are powers, dispositional properties or dispositions.' Dispositions are essential to our understanding of the world. This book is a record of the debate on the nature of dispositions between three distinguished philosophers - D. M. Armstrong, C. B. Martin and U. T. Place - who have been thinking about dispositions all their working lives. Their distinctive (...) accounts cover many of the issues surrounding dispositions such as the nature of mind, matter, universals, existence, laws of nature and causation. Dispositions illuminates this central topic in analytic philosophy and at the same time highlights deeper concerns of metaphysics. (shrink)

Stephen Mumford puts forward a new theory of dispositions, showing how central their role is in metaphysics and philosophy of science. Much of our understanding of the physical and psychological world is expressed in terms of dispositional properties--from the solubility of sugar to the belief that zebras have stripes. Mumford discusses what it means to say that something has a property of this kind, and how dispositions can possibly be real things in the world. His clear, straightforward, realist account reveals (...) them to be less mysterious than they seem, and shows that an understanding of dispositions is essential to an understanding of properties, causation, and scientific laws. (shrink)

Frank Jackson champions the cause of conceptual analysis as central to philosophical inquiry. In recent years conceptual analysis has been undervalued and widely misunderstood, suggests Jackson. He argues that such analysis is mistakenly clouded in mystery, preventing a whole range of important questions from being productively addressed. He anchors his argument in discussions of specific philosophical issues, starting with the metaphysical doctrine of physicalism and moving on, via free will, meaning, personal identity, motion, and change, to ethics and the philosophy (...) of color. In this way the book not only offers a methodological program for philosophy, but also casts new light on some much-debated problems and their interrelations. (shrink)

Dispositions are essential to our understanding of the world. IDispositions: A Debate is an extended dialogue between three distinguished philosophers - D.M. Armstrong, C.B. Martin and U.T. Place - on the many problems associated with dispositions, which reveals their own distinctive accounts of the nature of dispositions. These are then linked to other issues such as the nature of mind, matter, universals, existence, laws of nature and causation.

I. Causal Thesis: Dispositions have a causal basis. II. Distinctness Thesis: Dispositions are distinct from their causal basis. III. Impotence Thesis: Dispositions are not causally active.

Many existing biomedical vocabulary standards rest on incomplete, inconsistent or confused accounts of basic terms pertaining to diseases, diagnoses, and clinical phenotypes. Here we outline what we believe to be a logically and biologically coherent framework for the representation of such entities and of the relations between them. We defend a view of disease as involving in every case some physical basis within the organism that bears a disposition toward the execution of pathological processes. We present our view in the (...) form of a list of terms and definitions designed to provide a consistent starting point for the representation of both disease and diagnosis in information systems in the future. (shrink)

The concept of disease has been the subject of a vast, vivid and versatile debate. Categories, such as "realist", "nominalist", "ontologist", "physiologist", "normativist" and "descriptivist", have been applied to classify disease concepts. These categories refer to underlying theoretical frameworks of the debate. The objective of this review is to analyze these frameworks. It is argued that the categories applied in the debate refer to profound philosophical issues, and that the complexity of the debate reflects the complexity of the concept itself: (...) disease is a complex concept, and does not easily lend itself to definition. (shrink)

Science starts by using terms such as ‘temperature’ or ‘fish’ or ‘gene’ to preliminarily delimitate the extension of a phenomenon, and concludes by giving most of them a technical meaning based on an explanatory model. This transforma- tion of the meaning of the term is an essential part of its naturalization. Debating on the definition of ‘disease’, what most philosophers of medicine have examined is the pre-naturalized meaning of the term: for that reason they have focused on the task of (...) delimiting disease and non-disease (health), mainly used conceptual analysis as a method of choice, and considered the nosological level of ‘disease judgments’ rather than the pathophysiological or psychopathological level of disease mechanisms, thus making them impervious to most scientific discoveries. By focusing instead on the naturalized concept of disease and following some suggestions by philosophers of biology and scientists in cutting-edge fields of biomedical research, they could gar- ner results from a comparison of the mechanisms of diseases. This would ultimately result in a general theory of disease linked with our most general theories on living beings, among them, systems biology and network medicine. Before undertaking such a task, preliminary questions arise: is it likely that there are biological features common to different types of disease? Is it a philosopher’s job to determine what they consist in? What use would such a general theoretical definition of disease be? (shrink)

Many philosophers and medical scientists assume that disease categories or entities used to classify concrete cases of disease are often defined by disease mechanisms or causal processes. Others suggest that diseases should always be defined in this manner. This paper discusses these standpoints critically and concludes that they are untenable, not only when 'disease mechanism' refers to an objective mechanism, but also when 'mechanism' refers to a pragmatically demarcated part of the total "objective" causal structure of diseases. As an alternative (...) to principles that use the concept of disease mechanism or analogous concepts, a pragmatic approach is suggested and described. (shrink)